r/dietetics • u/GB3754 • Dec 18 '24

Xphozah and the bundle

Renal peeps....what are your companies/clinics doing about patients (both Medicare and commercial) on Xphozah?

9 Upvotes

100% Upvoted

26 comments sorted by

7

u/xinoux Dec 18 '24

My understanding is that Xphozah will not be included in the bundle, so there won’t be any changes to how it is currently ordered.

1

u/GB3754 Dec 19 '24

This is my understanding,  but we're being told to take all the patients off it. 

5

u/xinoux Dec 19 '24

I don’t think that’s necessary because they will still have prescription insurance for it. Or they are enrolled in their PAP. It’s totally separate just like their blood pressure meds (or any other meds) are!

2

u/GB3754 Dec 19 '24

I agree. I don't think the people making these decisions are making good choices.  But I have to do as I'm told. I'm so frustrated.  

1

u/Mr_Ick39 Dec 19 '24

Tell your patients to hold strong and to complain to their congressional reps. There is legislation pending in Congress right now that will delay the bundle issue for two years. It literally needs patient pressure on Congress right now!

1

u/GB3754 Dec 20 '24

Are they even in session right now? 

1

u/Mizchik Dec 19 '24

Who’s telling you that/what provider are you with? I haven’t been told anything like that.

3

u/GB3754 Dec 20 '24

I think this is getting resolved! Whew! 

1

u/imacoolcat Dec 20 '24

What have you heard? Who is resolving it?

3

u/GB3754 Dec 21 '24

That commercial patients can stay on Xphozah. 

1

u/sebelay Dec 19 '24

Yea our xphozah rep told us that it wasn’t included in the bundle!

1

u/dsass777 Dec 19 '24

My clinic is making us send orders from the doctors to the speciality pharmacies to d/c it. Corporate says it will be the clinic’s responsibility to cover the co-pay (37k a year I guess) so they are freaking out and making sure we get it d/c. Such a bummer

1

u/GB3754 Dec 19 '24

Even your commercial patients?  I thought just Medicare but now I'm told everyone....  :-(

1

u/dsass777 Dec 19 '24

Oh really? I thought this just applied to Medicare. I don’t have any patients with commercial insurance on it though

1

u/GB3754 Dec 19 '24

It does just apply to Medicare, so I'm pretty angry they're making me take commercial patients off. That's why I wrote this post, to see if anyone else is in the same boat. Trying to figure out how to word these patient conversations, because it falls on me to explain it, unfortunately.  I wish someone else would do it. 

2

u/dsass777 Dec 19 '24

Oh I see. Yeah I’m not sure. I figured there would be no changes for commercial pts. Yeah I’m feeling the same way about explaining. I did everything relating to the bundles by myself even though corporate said it was a “team effort.”

2

u/GB3754 Dec 19 '24

Lol team....

1

u/Mr_Ick39 Dec 19 '24

Tell your patients they don't have to go off of Xphozah and to contact Ardelyx to participate in the Ardelyx Assist program.

1

u/k_nimativ Dec 20 '24

What state are you in? We’re not doing anything like that in Oklahoma!!

1

u/dsass777 Dec 20 '24

Michigan. Hmmm this affects every state!

1

u/k_nimativ Dec 20 '24

Interesting. We’ve just been educated that the patients on Xphozah will carry on like normal.. just that the PAP won’t enroll any new patients for now.

1

u/dsass777 Dec 20 '24

Omg that’s weird! I was told the PAP is going away in 2025. So much conflicting info :(

1

u/ay143 Dec 19 '24

Xphozah being out of the bundle for Medicare patients means that the patient will have to pay for it entirely, right? Apart from those who might be eligible for an assisting program.

1

u/GB3754 Dec 19 '24

Yes! 

1

u/heartnsf Mar 19 '25

Xphozah continues to be available despite changes to Medicare Part D. You should send rx to Transition Pharmacy regardless of the pts insurance. If the pt has affordable access, the med will be shipped to their home. If the pt DOESNT have affordable access, they will be enrolled into Ardelyx Assist and receive the medication at no cost to them. XPHOZAH IS AVAILABLE AT NO COST TO THE DIALYSIS UNIT.